Dr. Blackburn serves as Associate Professor of Surgery and Nutrition, Associate Director of the Division of Nutrition, and is the first incumbent of the S. Daniel Abraham chair in Nutrition Medicine at Harvard Medical School. He is the, Chief of the Nutritional/Metabolism Laboratory, and Director of the Center for the Study of Nutrition Medicine, which are affiliated with the Beth Israel Deaconess Medical Center in Boston, Massachusetts.
Question: How do you ‘Break Though Your Set Point?’
Blackburn: It's been now almost 20 years since I published the first observation of the significance of a ten percent weight loss. And then it just built on that that was the amount of weight that people could lose without regaining it. So there is the stretch of the rubber band, and the amount of weight that you can lose and expect to keep off approaches ten percent of your body weight. So that's the reset that we want to do. We want to take that weigh on the scale and reset it, you know, with just under-eating 200 to 400 calories a day, one, two pounds per month, until you get the ten percent off. Now the average person, you know, starts-- should be weighing 150 pounds, they actually weigh 180 pounds, so we're really looking for a ten percent or an 18 or 20-pound weight loss in this area. And just with under-eating this little bit, getting rid of your hunger, eating slowly, will get the 20 pounds off, and lo and behold, that's the weight you can keep off. And so we ask people to stay there for six months, get this new eating and activity lifestyle, and then you can go to add another five pounds or ten pounds from that direction.
Question: How do we find our ideal weight?
Blackburn: To find what you should weigh is to know your actual weight in pounds and make a calculation of what's ten-percent less and go through that weight in pounds. The body mass index helps us normalize the society in females and males. So for scientific purposes and for medical evaluation, body mass index is a vital sign, just like weight circumference. But for the individual it's to know your weight, that's your set point, subtract ten percent of that weight and go to that new weight and see how good you feel and how healthy you are.
Question: Should thin people lose weight?
Blackburn: Well, the nice thing about it is that this intrinsic gut-bringing set point regulation will keep you close to your ideal weight. So if you're already at the weight most people of your height are at age 18, if you try to lose ten percent you'll find the brakes will go on at five percent. So you'll really be protected from losing too much weight. But you can test that to see how you feel. If I have more energy, more stamina, you know, I can perform better. Some people are. We're not all made in a cookie cutter so we're all one-size. Some people, your height could be five pounds or ten pounds less, and some people could probably be five pounds or ten pounds heavier to be at their best performance, their best hunger control, their best fitness.
Question: How does stress affect weight gain?
Blackburn: Almost anybody who changes weight more than one or two pounds, you know, per year can probably look back and find that something stressful happened in their life. A new job, a new marriage, you know, a new location, illness in the family, illness in themselves, so that stress is a major contributor, and therefore it's important that we identify that in ourselves and implement a plan to understand it and then to treat it. So that by virtue of the fact that you maintain your weight within one or two pounds year-in and year-out probably means you have manageable stress. You may feel stressed, but the good news is, it hasn't translated into changing your appetite or your activity so you're holding to your normal weight.
Question: How does sleep affect weight gain?
Blackburn: Sleep is a major contributor to our fighting stress and fighting fatigue, so that we know that if you are fatigued, undoubtedly you're not getting enough sleep. First you can know if I'm not getting six to eight hours of sleep per night, then I'm probably not getting enough, and it's wearing on me. The second thing of course if that when you wake up in the morning, if you don't feel refreshed then there was something wrong with the sleep. Wasn't long enough, you weren't restful enough, you weren't paying enough attention to all the tight controls to make sure that you have a blackout environment, you know, the right place to sleep. But I can't say enough about sleep contributing to the quality of life, contributing to the ability to eat healthy, to control your portions and feel good.
Question: Can we ever splurge?
Blackburn: You know, this religious, spiritual upbringing that has almost all religions take a day off, whether it's Friday, Saturday or Sunday. And so this day, this holiday, one day out of seven where you really concentrate on the joy of living, of the giving thanks to God or to other activities that for you make you feel good. If we don't get that once a day, it's just like not getting a sleep during the week, this works against us. So a day off for yourself, for prayer, for spirituality, for rest, for happiness are the components that you must add to the equation of the eating right, the eating healthy, the portion control, the physical activity, and the sleep management and stress we talked about.
Question: Do you advocate gastric bypass surgery?
Blackburn: Well, we've talked about the population on average having gained 24 pounds in the last 20 years. Now this is on top of the pound a year that people gain from age 20 to 50. So that instead of having 20 to 30 pounds over the 30 years of our adult life, we have 40 to 60. so that that would be a warning sign, particularly if it was associated with diabetes or hypertensive cardiovascular disease. But the gastric bypass is really focused on those people who gain three times too much weight. They're 100 pounds or more overweight. This is beyond our ability to make these lifestyle changes to lose enough weight to get healthy. So that fortunately for, if you will, severe obesity, we have developed safe and effective surgical approaches. But they still are just one component of the treatment. You still have to get the right diet, you still have to get the right portion control, you still have to get the right physical activity, the sleep, the day off, the happiness. So the surgery only helps the small component of our population. Unfortunately five percent of the population is five or ten million people, so it's not a small number of people. But compared to the 300,000,000 Americans, we would be talking about five or ten million people.
Question: Can food be addictive?\
Blackburn: I think it's better to characterize food as food cravings rather than addiction. We have some really tight definitions from drug and cigarettes and other addictions that don't exist as far as food is concerned. But food cravings definitely exist. And they're learned, and they require a special treatment by therapists to help you deal with food cravings. But that's manageable in many ways a lot easier than addictions such as smoking, or alcohol or drugs.